DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the 10^th  day of September, 2024

Present      :   Sri. Vinay Menon V., President

                    :   Smt. Vidya A., Member                        

                   :   Sri. Krishnankutty N.K., Member                                        Date of Filing: 30/03/2023 

                                      CC/91/2023

1. Anitha M.K.

W/o.Late Sureshkumar,

2. Sreyas P.,

S/o. Late Sureshkumar,

3. Thejas P.S.,

D/o. Late Sureshkumar,

(Complainants 2&3 being minors are represented by

their mother Anitha M.K., complainant 1 herein) 

4. Thanka

M/o. Late Sureshkumar.

All complainants are residing at
Parakalparambu, Kollengodekalam,

Kottayi (PO), Palakkad – 678 572                              -           Complainants

(By Adv. Joy Kanhirathinchalil)

                                                                                                Vs

Cholamandalam MS GIC,

2^nd Floor, Dare House No.2,

NSC Bose Road, Chennai – 600 001                            -          Opposite party

(By Adv. P. Prasad)

O R D E R

By Sri. Vinay Menon V., President

1. Complainants are the legal heirs of one deceased Sureshkumar, who died in a motor vehicle accident. Since the complainants had one and same interest in the reliefs, miscellaneous application, MA 5/2023 seeking permission to conduct the case jointly was allowed. At the time of accident, the deceased was insured with the OP. As per the insurance policy, they are entitled to get an amount of Rs.15 lakhs. But the OPs repudiated the claim for the reason that the complainant could not produce viscera report. An enquiry with the officials showed that the viscera of the complainant was not sent for chemical examination. There is deficiency in service on the part of OPs in seeking viscera report from complainant and resorting to non-disbursal of the insurance amount. Hence this complaint.
2. OPs filed version stating that there were in fact two policies.

One was a Standalone Own Damage policy in the name of the deceased which covered only the  own damage risks for the vehicle bearing Reg.No. KL-49-L-2663. There is no Personal Accident coverage for the deceased. No premium was received for coverage of the complainant’s life.

Second one was the Credit Linked Group Personal Accident Insurance Policy in the name of the deceased being a loan account holder of IndusInd Bank Ltd. The benefits available to the legal heirs of the deceased is only Rs.2 lakhs and not 15 lakhs. On enquiry the opposite party came to know that the deceased was under influence of alcohol at the time of accident and since this came under the purview of exclusion, they sought for viscera report which was not produced by the complainants. Since the said report was not produced the claim was repudiated. There is no deficiency in service or violation of policy terms and condition.

3.  The following issues were framed for consideration:

1. Whether the repudiation of insurance claim is as per the terms and conditions of the policy?
2. Whether there is any deficiency in service on the part of OP?
3.  Whether the complainant is entitled to any of the reliefs sought for?
4. Any other reliefs?

4.         (i)           Documentary evidence of complainant comprised of proof affidavit and Exhibits           

                          A1 & A11.   

(ii)            OP filed proof affidavit and marked Exts. B1 & B7.    

   Issue No.1

5.         Complainants’ case is that the deceased was having a coverage of Rs.15 lakhs, but pleadings and policy documents adduced in evidence prove that if at all entitled, legal heirs of the deceased are entitled only to Rs.2 lakhs under Chola Credit Linked Group Personal Accident Insurance, ie. Ext. B2.  

6.         In Section C “Other Findings” in Ext. A2 certificate show that stomach of the deceased contained 100ml of brownish fluid having sour odour.  It is based on this finding that the OP had sought for viscera report. Even after repeated requests the complainants failed to produce the same. It was in these circumstances the OP refrained from allowing the claim of the complainants for the benefits payable under the policy.

7.         Even though the first complainant had made enquiries with town north police station Palakkad she was informed that the medical office had not sent the viscera for chemical analysis. This certificate is produced and marked as Ext.A10.  This reply is corroborated by the entries in the reverse side of Ext.A2 wherein it can be seen that blood alone is preserved and sent for chemical analysis.  Part regarding viscera is scored off. 

8.         None of the documents produced by either party show that the complainants had intimated this fact to the OP. But fact remains that the OP had access to Ext.A2 post mortem certificate which is marked as Ext.B7 on the part of OP. Both are one and the same document. O.P. was bound to verify the contents of the said documents in its proper perspective by application of mind. Instead of applying their mind vigilantly to the facts and circumstances before them, they made the complainants run pillar to post when they were privy to the information that the viscera report was not available. 

9.         In such a circumstance seeking a non-existent viscera report from the complainants is unreasonable, arbitrary, vicious, vexatious and malicious.

10.       Conduct of the OP in asking for viscera report after having knowledge of the contents of Ext.B7 PMC is nothing short of vicious. We hold that conduct of the OP is malicious and illegal and therefore at variance with the terms and conditions of the policy.  

            Issue No.2

11.       Pursuant to the discussion in issue No.1, we hold that there is deficiency in service on the part of OP.  

            Issue No.3

12.       Complainant has sought for Rs. 15,35,000/- being the alleged sum assured along with interest and compensation and cost.

13.       But from a perusal of the documents it transpires the legal heirs of the deceased are entitled only for Rs.2 lakhs as can be seen in Ext.B2.  Complainants are entitled to this amount along with compensation and cost.

            Issue No.4

14.       Based on the discussions above, we allow the complaint with the following directions:

1.         Complainants are entitled to receive Rs.2 lakhs along with interest @10% from 13/1/2022 till the date of payment.

2.          Complainants are entitled to a compensation of Rs.1,00,000/-

3.          Complainants are entitled to punitive compensation of Rs.1,00,000/-

4.         Complainants are entitled to a cost of Rs.40,000/-.

5.         Each of the complainants shall be entitled to ¼th share of the aforesaid amounts in reliefs 1 to 4.

6.         The shares payable to complainants 2 & 3 shall be deposited separately as fixed deposits in a Nationalized bank, payable upon the minors attaining majority.

7.         OP shall comply with the aforesaid directives within 45 days of receipt of this Order, failing which they shall pay Rs.1000/- per month or part thereof as solatium from the date of this Order till the date of full and final compliance of this Order.

                        Pronounced in open court on this the 10^th   day of September, 2024.         

                             Sd/-                                                                                                                       

                                                                                                                Vinay Menon V

                                                                         President

                                                                               Sd/-

                      Vidya.A

                                              Member         

                         Sd/-

                Krishnankutty N.K.

                                                                                                                               Member      

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1   -  Copy of FIR bearing No. 55/2022

Ext.A2  –  Copy of PMC bearing No.PM5322   

Ext.A3   -  Copy of death certificate

Ext.A4   -  Copy of certificate of registration of bike bearing No.KL49L2663

Ext.A5   -  Copy of policy certificate of Standalone OD policy

Ext.A6   - Copy of driving license of deceased Sureshkumar  

Ext.A7   -  Copy of Final Report under Section 173CRPC

Ext.A8   -  Copy of relationship certificate  dated 16/2/2022

Ext.A9   -  Copy of query reminder cum closure letter dated 28/5/2022

Ext.A10   - Copy of reply dated 31/10/2022 under RTI Act  

Ext.A11   -  Copy of certificate of chemical analysis

Exhibits marked on the side of the opposite party:

Ext.B1 – Copy of policy certificate of Standalone OD policy

Ext.B2 – Copy of Credit Linked Group Personal Accident Insurance Policy   

Ext.B3 –  Copy of Claim query letter dated 16/3/2022  

Ext.B4 –  Copy of Claim query letter dated 21/4/2022    

Ext.B5 –  Copy of Claim query letter dated 17/5/2022      

Ext.B6 – Copy of query reminder cum closure letter dated 28/5/2022   

Ext.B7 – Copy of PMC bearing No.PM5322  

 Court Exhibit:  Nil  

Third party documents:  Nil

 Witness examined on the side of the complainant:  Nil

Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.